Provider Demographics
NPI:1750473120
Name:BRAUN, MARVIN D (DC)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:D
Last Name:BRAUN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:SD
Mailing Address - Zip Code:57533-1464
Mailing Address - Country:US
Mailing Address - Phone:605-835-8737
Mailing Address - Fax:605-835-8738
Practice Address - Street 1:114 E 6TH ST
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:SD
Practice Address - Zip Code:57533-1464
Practice Address - Country:US
Practice Address - Phone:605-835-8737
Practice Address - Fax:605-835-8738
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7602290Medicaid
0082501OtherBCBS
NE10025344000Medicaid
NE10025344000Medicaid
SD7602290Medicaid